| NPI | 1972605988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207PP0204X Emergency Medicine, Pediatric Emergency Medicine (Licence: CA A33639) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A33639) |
| 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: CA A33639) | |
| Enumeration Date | 2006-09-01 |
| Last Update Date | 2007-07-09 |